Agenda item

Consider update report by Director for Health & Social Care.  (Attached)

1.1         With reference to paragraph 4 of the Minute of the Meeting held on 10 May 2021, there had been circulated copies of an update report by Director for Health and Social Care Partnership that set out the actions taken by the Learning Disabilities Service (LDS) in relation to the recommendation within the Final Internal Audit Report – Learning Disabilities Service Financial Management dated 30 April 2021.  The report was presented by the Director for Health and Social Care Partnership, Mr Myers, who explained that LDS had undertaken a range of measures from the Heywood review on the Service’s financial situation with expected savings of £240,000 made from the current year.  However, in spite of work undertaken, costs were over those budgeted and the LDS had a starting deficit of just over £1 million.  While £300,000 had been identified to support these pressures, this still left £745,000, which was clearly significant.  Pressures were partly due to changes to demographic growth and the remainder was in relation to increases in packages of care for people with learning disabilities.  An enabling approach was being taken, with work underway to ensure dependence was not being created for service users.  Mr Myers gave details of progress on actions which had been self-assessed in the report, with a number of actions assessed as ‘green’ and a few assessed as ‘amber’.  Julie Heywood had been approached to come back in and assess actions in the report, hopefully by the end of March 2022.  With regards to action two of the report, an experienced Social Worker from another local authority was to be brought in by the end of April 2022 to provide a steer.  With regards to action three of the report, Mr Myers advised that he was working with the Director Social Work & Practice to ensure there was better professional alignment between adult and child Social Workers to ensure consistency of approach.  With regards to action four of the report, there were a number of high cost placements within the area where individual health and social care needs which had been reviewed through the NHS process resulting in high SBC costs.  The review of that process had started so there was more input from SBC, which should reduce the financial risk to the organisation.  With regard to action five of the report, the financial team was offering support to develop a set of tools to help social work staff in their approach to financial management.  With regard to action six of the report, this action would involve the community care review team which was involved with older adults to ensure better consistency for users.  With regard to action seven of the report, Mr Myers advised that the general manager was being asked to provide a detailed learning disabilities financial recovery plan for 24 March to deliver savings as quickly as possible.  Mr Myers advised that it was expected that a combination of the actions would set a better financial trajectory for the Learning Disabilities Service, that Audit and Scrutiny Committee had a key role in this process and that he proposed that the LDS financial management should be brought back for a further review in line with the outlined actions.

1.2         Members discussed the report and it was noted that, with reference to action nine of the report that figures related to the benchmarking unit price and budget expenditure of other Councils would have been useful to include in the report.  Mr Myers confirmed that he was happy to provide as much clarity as possible around benchmarking arrangements, but it could be difficult to benchmark in some areas of the Service while it would be easier in others.  One good benchmark may not be reflected in other parts of the Service but value for money was continually looked at through commissioning.  Mr Myers advised that there was a range of different benchmarking for the various parts of the Service.  Day service contract price was broadly in line with averages.  The bulk of the expenditure growth had related to an increase in volume which was the amount of care being provided to people.  With regards to variability of benchmarking, the impact of serving a large rural area with a relatively small population was noted.  With regards to £700,000 of savings required on the LDS, work was underway to take people out of costly placements and into good service with personalised support.  For the review of day services, there were a range of actions that did not just look at risk but also gave consideration to driving better value and providing a greater quality of service.  For other placements, how much health care a person needed affected the end cost and a more integrated process was being sought between NHS and the Council to ensure health also contributed funding.  With regards to action four on the breakdown of budget to east and west team level, this related to ensuring delegated budget responsibility in the Service.  The rationale was to ensure both east and west teams had clear budget oversight and were able to escalate identified issues.  Regarding the impact of increased fuel costs, Mr Myers noted there was an element of travel for both east and west teams and it was expected that there would be increased travel costs and that providers would expect there would be an uplift in operational costs.  Work was ongoing with commissioning teams to get best value.  With regard to action four on management of budgets, Mr Myers noted that there was a need to make sure the right decisions were being made for service users and finance, with the two aligning through an enabling approach which should reduce cost.  The action aimed to have delegated financial responsibility with guidance for when to escalate and work was being undertaken on tools to make this clearer.  The Director Finance & Corporate Governance  advised that the LDS had significantly exceeded its resources in the past, with part of the issue about needing clarity on volumes, client needs, etc. and progress had now been made on capturing this information.  If further challenges arose they would be managed corporately with a revised plan as had been the approach over the last few years.  Ms Stacey confirmed that this was an open audit item and the due date would be extended in line with timescales on the action plan and an associated follow-up would be undertaken, with a report back to the Committee in due course. 

DECISION

(a)       AGREED that the Director Health and Social Care would provide an update on LDS Financial Management actions for the meeting of the Audit and Scrutiny Committee in August 2022.

(b)       NOTED the update.